The eating disorder charity Beat estimates that 1.25 million people in the UK have an eating disorder. Eating disorders are complex mental illnesses, but with the right support, people can and do get better.
It can be difficult to know how to support someone you care about if they’re struggling with disordered eating. We spoke to Dr Jasmine Shingadia, Senior Counselling Psychologist, to find out what you can do if you’re worried about someone.
What are the first signs that someone might notice if a family member or friend has an eating disorder?
I think the first signs are a fixation on weight, shape, food, eating, or exercise.
Someone might be quite tired and unable to concentrate. And you might notice changes in behaviour, such as disappearing to the toilet after meals, avoiding eating with others, or struggling with changes to eating schedules or what meals consist of.
Other behaviour changes you might notice are things like increased irritability, isolation, and any signs of low self-esteem or low confidence.
What should people do if they spot some of these signs, if they’re worried about someone?
If you’re a parent and you think your child has an eating disorder, the first step is to try to talk to your child about it as gently as possible.
Choose a time and place where you’re not going to be interrupted – but don’t pick a mealtime or a time that’s too close to a meal.
Take some time beforehand to think about what you want to say; being informed on eating disorders is helpful. It’s important to mention why you’re worried or concerned, but don’t centre the conversation all on weight and food. Point out other signs of change too, such as mood changes or behaviour changes.
Sometimes it helps to practise what you want to say – you could roleplay with a friend or family member and see how the person might respond.
It could be helpful to think about opening up the conversation to understand how your child is feeling. Be mindful that your child might feel a bit defensive, angry, or upset – they might want to disengage from the conversation. It’s important not to feel too disheartened by that! We know that denial and secrecy are really common in eating disorders. Try to stay calm and avoid getting angry in response.
If your child does acknowledge that it’s a problem and they’re willing to get help, the first step is to arrange for them to see their GP.
If they continue to deny or disagree with you, bring up the conversation back up again at a different time. It’s best not to not just leave it and do nothing – have that conversation again and keep going.
If you’re a friend, it can be similar but different.
You might want to think about whether you’re the best person to have the conversation with the individual. Does it make sense for you to tell a family member or a teacher so they can approach the person instead? You might want to get another individual involved, preferably an adult, to help you and support you with what’s going on as well.
If you feel OK to have that conversation, lots of the same things apply. Be kind and understanding. Mention things that you’ve noticed, but not just food and weight changes. Maybe they’ve been turning down invites to come out with you, or being quieter, or seeming troubled.
It sounds like if someone’s noticed the changes you mentioned, it’s okay to say, ‘this is what I’ve noticed, and because I’ve noticed this, I’m worried that eating might have become difficult for you?’
Yes. I think one of the first steps is to speak up when you do notice. Even if someone might be a bit upset in that moment, they’ll appreciate your support in helping them notice and start to get help.
I wouldn’t advise people to just watch or wait and see. Eating disorders persist over time, so the longer any delay in getting help, the more difficult it can be by the time individuals come to treatment. It’s important to seek help as soon as you’re noticing or worrying about your own behaviour or someone else’s behaviour.
Eating disorders are mental illnesses, and it’s not necessarily possible to gauge individuals’ need based on weight alone. Weight can go up or down or stay the same during an eating disorder, and behaviours don’t necessarily have to be dramatic or get worse in order for them to be problematic.
I think it requires a lot of bravery to have that difficult conversation, but in the future, you can imagine that person will probably be grateful that you’ve been supportive and not ignored it.
Exactly. And like I said, it could be a bit more difficult as a friend, but you could ask another friend or family member to help you support you.
If you’re not feeling up to having that conversation, that’s also fine! It’s then about telling someone else who you can do that for you. It’s about noticing, and then doing something and not allowing secrecy to thrive.
How can people support family members or their friends to recover if they’re struggling to engage with support and treatment?
That can be really difficult. If you’re a family member trying to help your child, you could go along with them to their appointments – helping them to attend can be very helpful.
Think about what the person finds helpful at meal times. What could you talk about? Think about anything you can do to help with distraction or engaging them in other activities before or after meal times, which can also be particularly distressing times.
Avoid discussing certain topics that can be particularly triggering, such as diet, exercise, or your own food or body image issues.
We know that individuals with eating disorders can become much more withdrawn, so try to include them in activities to stop them from isolating themselves. Try to think of social activities that aren’t food or exercise related.
And talk to them about things outside of their illness! Your loved one is still interested in other things and helping to return hobbies that they used to enjoy (or hobbies that they’ve not tried) might be helpful. We know that being consistent in that love, care, and support is valuable.
An eating disorder can make people behave in ways that seem a bit out of character, they can become quite upset and frightened easily. It could become quite emotional at times. Your attempts to help could be quite difficult for them to take as well. So it can be helpful to have some ways of managing heated situations, like taking a break and returning to the situation later.
If someone you care about has an eating disorder, it can also take a toll on you, so make sure that you’ve got support in place too.
It sounds like it might be really valuable just to have a friend or a family member to do ‘normal’ things with, like watching your favourite shows you’ve always watched – carrying on with those things and supporting your loved one to have a life beyond having an eating disorder?
Yes. We know engaging in activities beyond eating is really helpful in terms of recovery. If a young person is engaging in things that they enjoy (or used to enjoy), it can make the eating disorder a bit quieter at times.
It can also give people hope and reasons to recover. While watching a TV show with a friend, for example, someone might remember that in the past, they would have found it funny. Maybe they don’t have that at the moment, because the eating disorder takes that joy or expression of emotion away from them. That could be a way of helping them to reflect and think about recovery and what they want their life to look like.
Have you got any words of wisdom about social media?
I think this is a really topical conversation at the moment. We know that social media has good and bad effects on young people in general. But we know that pro eating disorder content can be quite widespread on social media and it’s harmful.
It’s helpful to sort of reflect and think about how social media is making you feel, including in relation to the eating problems. People can unfollow accounts and make sure they’re not seeing content that doesn’t make them feel good about themselves.
You can also think about using accounts that promote recovery and positive body image as well. It’s about curating the content you see so it’s going to be helpful!
It could also be considering when individuals are using social media. Are they using it at times where actually it might be better to do an alternative activity?
If people are struggling with an eating disorder, it sounds like they need to decide what’s helpful for them, rather than what’s backing up the eating disorder itself.
In those cases, it could be helpful to have a friend or family member sit down with them and help them make decisions about who they’re following. Sometimes the eating disorder might sort of take over and convince someone that content is fine, when actually, in reality, it might not be. So it could be helpful to have another person who’s going to offer reasoning and support.
The last thing we wanted to ask is whether it’s possible to fully recover from an eating disorder?
Yes, it is! It’s possible to fully recover from an eating disorder.
We talk a lot about recovery and recovering not being a linear process, it can be up and down. Generally, it takes time, and work, and education – but we know that people recover and go on to live really happy lives.
In terms of what recovery really looks like, it’s things like having decreased anxiety around food, being able to eat what you like when you like, and not missing out on events or life because of your eating disorder. It’s being able to engage better with school or work or studying, hobbies, and seeing your friends and family. It’s about not having to adjust your life around the eating disorder.
But we know that there are times when that eating disorder ‘voice’ might get a bit louder or be a bit more difficult for people, even in recovery. They may have moments where the eating disorder feels like it’s come back, or it feels like a slip, and therefore people need to continue to work on that.
One of the things we do through treatment is having a relapse prevention plan. When you make one, you consider what you might notice if things are a bit off track, and how you’d get yourself back on track. What other things can you do, how could you seek help again?
Those things are important because again, we know that an eating disorder perpetuates over time. If things are feeling tricky, even in recovery, it’s important to take action! We know that doing that’s helpful and can make the impact the eating disorder symptoms might be having short-lived.